NUR 550 Identify the different levels of translational research

Using the GCU library via the Pub Med database, I located the article “A randomized controlled trial protocol comparing the feeds of fresh versus frozen mother’s own milk for preterm infants in the NICU”, published in the Trials Journal. This article was a double-blinded randomized, and controlled study that targeted the feeding policy for preterm infants (< 32 weeks) in the neonatal intensive care (NICU) setting.

The feeding policy for preterm infants is significant because this population of patients is at risk of acquiring necrotizing enterocolitis (NEC). NEC is a severe inflammatory illness of the intestine, primarily affecting very low birth weight (<1500 grams) or very premature infants (< 32 weeks gestation). NEC is also the leading cause of death for infants in the NICU (Sun et al., 2020).

In their study, Sun et al., 2020, determined the incidents of (NEC) after study participants were fed fresh unprocessed (within 4 hours of expression) mother’s own human milk versus mother’s own frozen human milk for preterm infants (<30 weeks gestation) in the NICU. According to Sun et al., 2020, the current process for the NICU in the study provides expressed breast milk (EBM) that is stored and frozen, then thawed and warmed prior to being fed to the infant, which decreases some of its bioactive properties.

Therefore, Sun et al., 2020 conducted a pilot study whereby the feasibility and safety of feeding the infant with mother’s own fresh human milk was tested, illustrating that one feed of fresh human milk per day was safe and feasible in the NICU, and it also reduced morbidity for infants who are < 30 weeks gestation.

The type of translational research (TR) that was used for this study was the T0 – T1 phases where preclinical studies were done first to test for the treatment’s safety (T0), then the treatment was provided after it was proven as safe and feasible (T1). This is the best TR study because it translates observed science into clinical practice, changing the feeding policy for vulnerable preterm infants, which could also save many preterm infants’ lives in the NICU.

References

Sun, H., Cao, Y., Han, S., Cheng, R., Liu, L., Liu, J., Xia, S., Zhang, J., Li, Z., Cheng, X., Yang, C., Pan, X., Li, L., Ding, X., Wang, R., Wu, M., Li, X., Shi, L., Xu, F., . . . Lee, S. K. (2020). A randomized controlled trial protocol comparing the feeds of fresh versus frozen mother’s own milk for preterm infants in the NICU. Trials, 21(1), 1-11. https://10.1186/s13063-019-3981-4

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Through my search of the PubMed database on the GCU library page, I found the article, “Nasal High-Flow Therapy During Neonatal Tracheal Intubation” published in The New England Journal of Medicine. This study compared the success of first attempts at intubation without physiological instability (bradycardia and desaturation) between infants who received high flow nasal oxygen during the procedure and those who did not (Hodgson et al., 2022).

This trial represents phase 2 and 3 clinical trials which involve comparing the safety and efficacy of a proposed intervention to current practice in a human group. Translational research is an appropriate method for evaluating the benefit of this intervention because the process that translational research follows can foster the successful implementation of evidence into practice in order to improve care and health outcomes (Titler, 2018).

The results of this published study showed promising results. The next steps in the translational research process include phase 4 clinical trials focusing on clinical outcomes and translation to practice and phase 5 research focusing on population-level outcomes and the translation of this intervention into community practice. If this change in practice continues to show promising results through the completion of the translational research phases, we can hope to see this new intervention incorporated into evidence-based practice.

References:

Hodgson, K. A., Owen, L. S., Kamlin, C. O. F., Roberts, C. T., Newman, S. E., Francis, K. L., Donath, S. M., Davis, P. G., & Manley, B. J. (2022). Nasal high-flow therapy during neonatal endotracheal intubation. The New England journal of medicine, 386(17), 1627–1637. https://doi.org/10.1056/NEJMoa2116735

Titler, M. G. (2018). Translation Research in Practice: An Introduction. Online Journal of Issues in Nursing, 23(2), 1. https://doi-org.lopes.idm.oclc.org/10.3912/OJIN.Vol23No02Man01

After exploring the GCU Library, I identified the Journal of Pediatric Nursing as one of the main collection of resources that focuses on translational research. A common population health issue of interest from the studies published in this journal is safety and quality of care for hospitalized children. For example, the article ‘Promoting patient safety in hospitalized children: A paramount concern for pediatric nursing’ discusses interventions for promoting patient safety in regard to hospitalized children (Christian, 2022). On the other hand, the journal article ‘Pediatric nursing: Caring for children’ discusses the best interventions in improving the nursing practice in provision of health care to children (Christian, 2020).

Implementation science is the type of translational research used in both studies. Implementation science is the branch of science that emphasizes on testing implementation interventions in order to promote acceptance and application of evidence that can enhance patient outcomes and the overall population health (Titler, 2018). In particular, the T0/Basic Science Research level of translational research is the research type in these articles. With sufficient research-based evidence being available, the clinical interventions should be based on the research findings. This is why this translational research is the best.

References

Christian, B. J. (2020). Translational research – Pediatric nursing: Caring for children. Journal of Pediatric Nursing, 54, 103–105. https://doi-org.lopes.idm.oclc.org/10.1016/j.pedn.2020.08.002.

Christian, B. J. (2022). Translational research – Promoting patient safety in hospitalized children: A paramount concern for pediatric nursing. Journal of Pediatric Nursing, 63, 156–158. https://doi-org.lopes.idm.oclc.org/10.1016/j.pedn.2022.02.015.

Titler, M. G. (2018). Translation Research in Practice: An Introduction. Online Journal of Issues in Nursing, 23(2), 1. https://doi-org.lopes.idm.oclc.org/10.3912/OJIN.Vol23No02Man01.

I agree with you that implementation science is the branch of science that emphasizes on testing implementation interventions. Testing implementation interventions creates room for improvement. At the same time, testing the interventions promote acceptance and application of evidence that can enhance patient outcomes. Implementation science is the type of translational research important in healthcare settings (Rubio et al., 2019). Planning and implementation of healthcare initiatives takes prolonged time and many resources. Implementation science allows healthcare stakeholders to weigh the possibility of successful and impactful implementation of health program (Allen Jr., 2019). Healthcare organizations continuously work on improving their patient outcomes. Continuous quality improvement (CQIs) routines are common in healthcare environment. Research provides factual information that guides CQIs. Translational research is suitable in addressing human health issues. The research provides information that can be readily used in addressing health problem.

References

Allen Jr, B., Seltzer, S. E., Langlotz, C. P., Dreyer, K. P., Summers, R. M., Petrick, N., … & Kandarpa, K. (2019). A road map for translational research on artificial intelligence in medical imaging: from the 2018 National Institutes of Health/RSNA/ACR/The Academy Workshop. Journal of the American College of Radiology, 16(9), 1179-1189. https://doi.org/10.1016/j.jacr.2019.04.014

Rubio, I., Osuchowski, M. F., Shankar-Hari, M., Skirecki, T., Winkler, M. S., Lachmann, G., … & Bermejo-Martín, J. F. (2019). Current gaps in sepsis immunology: new opportunities for translational research. The Lancet Infectious Diseases, 19(12), e422-e436. https://doi.org/10.1016/S1473-3099(19)30567-5

NUR 550 Identify the different levels of translational research